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  • Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee


Potential partners include: • Healthwaves Corporate Wellness Team (provides workplace inuenza vaccine clinics with an estimated 50 people immunized per hour) medicine in the middle ages discount requip 1mg without a prescription. The quantity of vaccine and the prioritized target groups to symptoms before period cheap requip 0.5mg line vaccinate will be factors inuencing these resource needs medications dialyzed out effective requip 2 mg. Facilities housing mass vaccination clinics must meet requirements for proper vaccine storage and handling medicine expiration dates cheap requip 0.5 mg line. They will designate a point of contact, if other than the County Immunization Manager listed in Attachment 2 of this “Arizona General Pandemic Inuenza Mass Vaccination Plan. They will adjust their existing mass vaccination plans to accommodate the unique requirements of pandemic inuenza vaccine. More details on mass vaccination clinics can be found in the “Arizona Mass Vaccination Clinic Plan” (Appendix 2). Vaccine Clinic or Dispensing Site Facility Information Formal or Vaccination Informal Has Facility Vacc/Disp or Facility Facility Facility Facility Facility Agreement Been capacity per Dispensing Phone Fax Name Address Contact with Facility Assessed for day (# of Site Number Number Owner Adequacy These clinics will immunize individuals who cannot afford the vaccine administration fee for pandemic inuenza vaccine. However, providers cannot charge for federally-supplied pandemic inuenza vaccine or ancillary supplies. These public health entities will need to collaborate with various community sectors to plan for the allocation and administration for pandemic inuenza vaccines. Vaccination planning activities would include: • Determining how they will operationalize their plans for giving pandemic inuenza vaccine to the people in their jurisdiction. The clinic personnel should include a Safety Chief who is responsible for crowd control, determining the security needs, overseeing the security personnel, and coordinating with local law enforcement if additional security is required. Public high schools can be considered as a site for mass vaccination clinics during a pandemic. The rationale for using high schools is: • 464 high schools are located throughout the state and their locations correlate with the state’s population. The Director or designee will contact the Department of Education representative who will facilitate the dedication of appropriate resources for this purpose. These issues, along with the large number of high schools statewide, also preclude on-site assessments for facility adequacy for State Clinics. Vaccine Safety Monitoring Comprehensive screening techniques of potential vaccine recipients will minimize the vaccinating an individual with contraindications or precautions. Individuals will receive educational information prior to vaccination and will be advised of what symptoms to expect after vaccination, if any. They will proceed to a nal check out area where a medical counselor answers any additional questions and collect forms as needed. Vaccinators need to have enough medical or health background to be trained in proper and safe administration of vaccine. Contraindications the level of contraindications will depend on the risk of the inuenza pandemic. The contraindications for the inuenza pandemic vaccine are assumed to be the same as the seasonal inuenza vaccine. Pandemic inuenza vaccines will be made using the same manufacturing process as seasonal inuenza vaccines. The safety prole of pandemic inuenza vaccines is expected to be similar to seasonal inuenza vaccines. However, for any vaccine, rare side effects can only be detected by monitoring for adverse events after vaccination. This can be either within their mass vaccination clinic or in separate off-site locations. Whenever possible, telephone triage should be used in order to minimize unnecessary use of the post-vaccination adverse events evaluation sites. Adverse Events Management It is difcult to know the precise numbers of people who will seek medical care after mass inuenza pandemic vaccination. Therefore, mass vaccination will create health care demands for vaccine education, vaccine administration, and evaluation of adverse events. Pre-vaccination education, mass media education of the public and health care providers, education about locations of additional resources for patients and health care providers, and continued education of health care providers about adverse events will all be needed. Serious adverse events should be evaluated quickly by a physician or in an emergency department. The vaccine recipient will be told to contact his/her primary care provider for evaluation and management of serious adverse events. The term “638” refers to this law through which tribes can operate part or all of their health programs, including hospitals and clinics. Information on American Indian Health Facilities, including tribally-operated 638 health programs, can be accessed at. Mojave Indian Tribe San Juan Southern Paiute Tribe John Manning, Director Carlene Yellowhair Fort Mojave Indian Health Center President 1607 Plantation Rd. Arizona Advisory Council on Indian Maria Dadgar, Executive Director Health Care 2214 N. Overview of vaccination components of a mass vaccination clinic the comprehensive screening techniques of vaccine recipients should minimize the vaccinating an individual with contraindications or precautions. Individuals will receive educational information prior to vaccination and the post vaccination symptoms to anticipate, if any. People who do not have contraindications will receive vaccinations, and have the vaccine documented on an immunization card. Screeners, vaccinators and medical counselors will be trained personnel with a health or medical background. Screeners and medical counselors need to have enough experience and training to make adequate clinical judgments about contraindications and risk of exposure. Translators for common languages will be an essential part of stafng a mass vaccination clinic to assure adequate education. R4-23-411 Upon receipt of a valid prescription order and completion of training may administer all vaccines to adults and to children 6 years and older. Pharmacists can administer many vaccines without a prescription: inuenza vaccine to patients 3 years and older; most vaccines to adults 18 years and older (except as specied in A. R9-6-1301); may administer specied vaccines to adolescents; and may administer vaccines to patients of any age when there is a public health emergency. In which case, members whose licenses are inactive may be utilized in the same manner as those with current licensure. Assignments In the event of a large public health emergency, on the rst day of emergency clinic operations, • Provide “Just-in-time” training • Establish on-site personnel assignments • Determine stafng needs determined • Make shift assignments A skills assessment will be conducted to determine the appropriate job assignment for the volunteer. Though there are some tasks that members whose licenses have expired will be prohibited from performing such as vaccinations, their expertise and training may be utilized in other areas such as review of medical information, exit interviews, supply management, etc. Training All volunteers will be required to receive training in patient condentiality and bloodborne pathogens/ universal precautions prior to working with the public. Mass Vaccination/Mass Dispensing Clinics On the rst day of clinic operations, offer vaccination to clinic staff and their immediate family members, if available and authorized. Vaccinators/ Must be allowed Alternates between administering vaccination, Witness to administer filling out vaccine card, and signing as witness. Exit Medical or public Answers final questions about site care, adverse Reviewers health personnel event symptoms or non-take reporting procedures/ follow-up, and other issues following vaccination. They should be able to answer questions and have the skill to keep people calm and deal with large crowds. All clients will be asked to complete and read the Immunization Screening Form and the Consent Form. Each client must provide name, birth date, age, complete address and phone number. Nurses (or available staff) will be available to clients waiting in line to answer questions and assist with completing the forms. Consideration should be given to using licensed healthcare personnel to screen clients for immunization history. Explain to client about the vaccine being given and screen the client for any contraindications to the vaccine.

Ventilator-associated pneumonia: present understand disease caused by novel influenza A H7N9 virus and sustained viral shedding and ing and ongoing debates 300 medications for nclex generic requip 2mg with mastercard. Influenza and the rates of hospital infected with 2009 pandemic influenza A (H1N1) virus symptoms 2 year molars purchase requip 0.25mg otc. Clin Infect Dis 2010; ization for respiratory disease among infants and young children medications made from plants order 0.5 mg requip visa. Efficacy and safety of long-term sirolimus composed of amantadine medicine x pop up requip 0.25mg free shipping, oseltamivir, and ribavirin impedes the selection of therapy for Asian patients with lymphangioleiomyomatosis. Safety and efficacy of nebulized zanamivir in hospitalized patients with pneumonitis during mammalian target of rapamycin inhibitor therapy: radio serious influenza. A community cluster of influenza A(H1N1) influenza A/H3N2 viruses shed during 1 year by an immunocompromised child. Surviving sepsis campaign: international oseltamivir-resistant pandemic H1N1 virus during prophylaxis. Designing and conducting a randomized nidase confers high-level resistance to oseltamivir in influenza B viruses. Recovery of drug-re therapy on influenza-related mortality: a systematic review and meta-analysis. Corticosteroids for the treatment of human child treated with oseltamivir and zanamivir. Corticosteroid treatment in critically ill patients individual and household transmission studies. Early use of glucocorticoids was a risk factor for critical Antivir Ther 2012; 17:955–64. The influence of corticosteroid treatment on the outcome of influ omized, double-blind, placebo-controlled safety trial over 16 weeks. Effect of low-to-moderate-dose corticosteroids on poietic stem cell transplantation: risk factors, mortality, and the effect of antiviral mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 therapy. Adjuvant corticosteroid treatment in adults with in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among influenza A (H7N9) viral pneumonia. Oseltamivir, zanamivir and amanta patients hospitalized with severe influenza infection may affect clinical outcomes. Prolonged viral shedding influenza A virus isolated in Gyeonggi Province, South Korea, during 2005–2010. Viral loads and duration of viral shedding in adult ivir among seasonal influenza A(H1N1) viruses: 2008–2010. Emergence of resistance to oseltam pies in patients with pandemic influenza A (H1N1) 2009 complicated by pneu ivir among influenza A(H1N1) viruses in Europe. Convalescent plasma treatment reduced mortality virus variants with reduced oseltamivir susceptibility—North Carolina and South in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Anti-inflammatory effects of adjunctive mac care facilities: a cluster randomised controlled trial. Inhaled zanamivir versus rimantadine en-oseltamivir combination in the treatment of patients hospitalized for influ for the control of influenza in a highly vaccinated long-term care population. Use of the selective oral neuraminidase trolling influenza outbreak in nursing homes: a comparison between three differ inhibitor oseltamivir to prevent influenza. Detection and control of influenza outbreaks Zanamivir in the prevention of influenza among healthy adults: a randomized in well-vaccinated nursing home populations. Short-term treatment with the effectiveness of interventions in long-term care facilities: a systematic review. Effectiveness of oseltamivir in preventing influenza in house Health (Oxf) 2007; 29:88–90. Zanamivir prophylaxis: an their impact in elderly care facilities: a review of the literature. Age Ageing 2010; effective strategy for the prevention of influenza types A and B within households. Management of influenza in house respiratory tract infections outbreaks in nursing homes in France. Eur J Epidemiol holds: a prospective, randomized comparison of oseltamivir treatment with or 2009; 24:149–55. Efficacy and safety of inhaled zan ters of seasonal influenza in a Swiss geriatric hospital. J Am Geriatr Soc 2015; amivir in the prevention of influenza in community-dwelling, high-risk adult 63:739–44. High morbidity and mortality associated with an ing and treating influenza in healthy adults: systematic review and meta-analysis. Long-term use of oseltamivir for the Pneumonia and influenza hospitalizations in elderly people with dementia. Use of oseltamivir during influenza hematopoietic cell transplant recipients and patients with hematologic malignan outbreaks in Ontario nursing homes, 1999–2000. Evaluation of the use of oseltamivir proph pneumonia caused by the drift variant A/Victoria/361/2011-like H3N2 viruses, ylaxis in the control of influenza outbreaks in long-term care facilities in Hong Kong, 2011. Effect of antiviral prophylaxis on influenza Infect Control Hosp Epidemiol 2004; 25:955–61. Oseltamivir treatment and prophylaxis in a neona cine programme for care home staff to prevent death, morbidity, and health tal intensive care unit during a 2009 H1N1 influenza outbreak. J Perinatol 2011; service use among residents: cluster randomised controlled trial. Estimating the effect prophylaxis for influenza in pediatric wards oseltamivir or zanamivir after rapid of influenza vaccination on nursing home residents’ morbidity and mortality. Risk factors for outbreaks of influenza in chemoprophylaxis in controlling nosocomial influenza: an observational study. Cluster of oseltamivir-resistant 2009 pandemic ple of nursing homes during an influenza epidemic. Am J Public Health 1995; influenza A (H1N1) virus infections on a hospital ward among immunocompro 85:399–401. Use of influenza and pneumococcal pneumonia in Canadian long-term care facilities: oseltamivir in Dutch nursing homes during the 2004–2005 influenza season. Use of oseltamivir during an outbreak influenza B in a nursing home from a culture-positive roommate. Nosocomial influenza out of the Advisory Committee on Immunization Practices—United States, 2018-19 break in a geriatrics department: effectiveness of preventive measures. Nosocomial vs community-acquired antiviral prophylaxis during nursing home outbreaks of influenza A: a compari pandemic influenza A (H1N1) 2009: a nested case-control study. Effects of early oseltamivir therapy on viral a systematic review of systematic reviews. Open tion prophylaxis with oseltamivir in nursing homes: a randomised controlled trial Forum Infectious Diseases, ofy209. See full prescribing information for baloxavir marboxil or any of its ingredients. Approval: 2018 influenza-like symptoms, may coexist with, or occur as a complication of influenza. Limitations of Use: Influenza viruses change over time, and factors such as the virus type or subtype, emergence of resistance, or changes in viral virulence could diminish the clinical benefit of antiviral drugs. Serious bacterial infections may begin with influenza-like symptoms, may coexist with, or occur as a complication of influenza. Prescribers should be alert to potential secondary bacterial infections and treat them as appropriate. There are risks to the mother and fetus associated with influenza virus infection in pregnancy (see Clinical Considerations). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defects, loss, or other adverse outcomes. Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Pregnant women are at higher risk of severe complications from influenza, which may lead to adverse pregnancy and/or fetal outcomes including maternal death, stillbirth, birth defects, preterm delivery, low birth weight and small for gestational age. Data Animal Data Baloxavir marboxil was administered orally to pregnant rats (20, 200, or 1,000 mg/kg/day from gestation day 6 to 17) and rabbits (30, 100, or 1,000 mg/kg/day from gestation day 7 to 19). In rabbits, fetal skeletal variations occurred at a maternally toxic dose (1,000 mg/kg/day) resulting in 2 abortions out of 19 pregnancies. In the prenatal and postnatal development study in rats, baloxavir marboxil was administered orally at 20, 200, or 1,000 mg/kg/day from gestation day 6 to postpartum/lactation day 20.


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Because the drug is cleared from the body slowly treatment hyperkalemia buy discount requip 0.25 mg online, pegylated interferon can be given once a week medications similar to gabapentin cheap requip 2mg mastercard. Although the actvity of interferon is decreased by the atachment of peg molecules to medicines generic 0.5mg requip free shipping it medicine identifier generic 1 mg requip fast delivery, the longer duraton of acton counteracts the reducton in immune actvity. The overall sustained response rates with these two pegylated interferons in combinaton with ribavirin are approximately 53% to 55%. One trial conducted exclusively among patents with cirrhosis reported a 29% sustained response rate with pegylated interferon alfa-2a compared to a 6% response rate with non pegylated interferon alfa-2a. Another internatonal, mult-center trial wherein 28% of the patents had cirrhosis reported that this group of patents had a overall sustained response rate of 39% with pegylated interferon alfa-2a compared to a 19% sustained response rate for non-pegylated interferon alfa-2a. Other Interferons Albinterferon alfa-2b (Albuferon™) is a long-actng interferon that has the potental for every 2 week or every 4 week dosing. The atachment of interferon alfa to the naturally occurring protein albumin keeps actve interferon molecules circulatng in the body for an extended period of tme (a prolonged half-life). Two large studies with this drug include treatment naive patents with genotypes 1 and genotypes 2/3 using an every two week dosing schedule for albinterferon alfa-2b. Possible treatment advances that may be possible with the successful development of longer actng interferons include: y longer intervals between interferon dosing y improved sustained viral response rates y fewer treatment side effects New delivery systems for interferons are also being explored including contnuous release preparatons, pumps, and depo preparatons. Chapter 8: Western (Allopathic) Medicine Section 4: Future of Allopathic Hepatitis C Treatment Therapies That Modulate the Immune Response Vaccines Vaccine research has historically focused on preventng infecton. Scientsts are now atemptng to develop vaccines to either protect people from developing chronic infecton or to modify the course of chronic infecton. Vaccine development begins in the research laboratory where potential vaccine components are studied in animals and living cells. This characteristic of the virus makes it difficult to provide long-term, antibody-based immunity. Thus, an effective vaccine must stimulate T cells, immune system partners to the antibody-producing B cells. The underlying concept behind vaccination is that a vaccine will stimulate the immune system to respond to a specific infectious agent leading to elimination of the agent or limitation of its harmful activities. A specific antibody will react only with the agent that stimulated its production. This highly specific interaction is often described as being similar to a lock and key. These small changes may make the virus unrecognizable to specific antibodies against the virus. Therefore, developing a vaccine to stimulate the production of antibodies that will continue to recognize the virus long-term and provide protection is challenging. The immune system has a highly developed surveillance system to detect the presence of any substance foreign to the body (such as viruses and bacteria). The detection of an “invader” leads to a complex series of immune response that are intended to eliminate the invader. Thus, the detection of a foreign substance is the first step in the immune response. This may be partially responsible for the fact that some people 135 Copyright © 2008, Caring Ambassadors Program, Inc. Resistance to drug therapy refers to the ability of the virus to “escape” the effects of a drug and continue to multiply after an initial period of response. However, the emergence of treatment resistance remains a serious concern as more therapies are developed. This helps the virus survive by allowing it to escape detecton and recogniton by the immune system’s B cells and T cells. T cells are immune cells that interact directly with infectous agents and infected cells. Lymphocytes that travel to the thymus gland to mature become T lymphocytes or T cells. T cells are the primary actors involved in the cellular immune response, which is partcularly important in batling viral infectons. Thymosin fracton 5 and thymalfasin (Zadaxin, also known as thymosin alfa-1) are two special types of proteins called cytokines derived from the thymus gland. Chapter 8: Western (Allopathic) Medicine Section 4: Future of Allopathic Hepatitis C Treatment Thymalfasin stmulates the immune system. Other Therapies That Modulate the Immune System Interferon works by stmulatng the immune system. Research has shown that these molecules have antviral actvity, but none have yet proven both safe and efectve. In other words, interferon-based therapy boosts the immune system to that it can kill the virus. These agents are designed to interfere with the virus directly by targetng molecules essental to the lifecycle and replicaton of the hepatts C virus. The genome contains the specifc informaton that makes a tree a tree, a virus a virus, and a human a human. The types of proteins made by an organism determine how it lives, functons, and survives. Enzymes are specialized proteins that are necessary for various chemical reactons. Such barriers include the need for inhibitors to have actvity against a broad range of virus genotypes and quasispecies, and the potental development of resistance to the drugs. Due to the development of resistance with this class of drugs, it is unlikely in the near future that they will be considered for monotherapy. These agents are taken by mouth, and are intended to be used in conjuncton with interferon-based therapy. Sustained viral response was reported for 61% of those that received 24 weeks of treatment, and 67% for those receiving 48 weeks of treatment. There was a greater incidence of rash in the telaprevir arms of these trials than in the control groups that were given pegylated interferon and ribavirin alone. Chapter 8: Western (Allopathic) Medicine Section 4: Future of Allopathic Hepatitis C Treatment with pegylated interferon plus ribavirin. Further study is needed into the appropriate balance between safety and efectveness with this drug. This medicaton may possess direct antviral efects or works through general immune stmulaton. However, there were serious side efects when these molecules were administered to animals. It is unclear whether ribozymes may have a role in therapy for chronic hepatts C at some tme in the future. However, development of this agent was halted because of heart problems in monkey. Companies are currently conductng research to determine if products that work by this mechanism may be useful in the treatment of hepatts C. To this end, companies are currently investgatng therapies to slow down or prevent liver damage caused by the hepatts C virus. Chapter 8: Western (Allopathic) Medicine Section 4: Future of Allopathic Hepatitis C Treatment Ribavarin Analogues Ribavirin is one component of current standard therapy. Several pharmaceutcal companies are currently involved in developing improved versions of ribavirin. The new compounds are chemically altered versions of ribavirin and are known collectvely as ribavirin analogues. Taribavirin (also known as Viramidine) Taribavirin is a liver-targetng prodrug of ribavirin. The role of herbal and other therapies in controlling arthralgia, myalgia, mental fogginess, and fatgue is clear to individual patents. However, research data are needed to support broad usage of these agents in symptom management across diverse populatons. The possible ant-infammatory role of herbal therapies to prevent or slow disease progression must also be explored. We need to determine the actual incidence of these reported side efects and document their severity with carefully designed clinical studies.

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Alcohol medicine 3604 pill requip 0.25 mg, envi ronmental pollutants treatment hyperthyroidism buy generic requip 0.25 mg line, food preservatves and additves symptoms 6 months pregnant cheap requip 0.5mg, drugs symptoms for pregnancy buy requip 1mg with visa, and other toxic substances can challenge the liver’s ability to functon efectvely. The Healing Power of a Positive Attitude How do you meet the demands of a disease like hepatts C and live a full life Without qualites such as endurance, integrity, honor, and self-esteem, healing the physical body is a difcult task. Consider positve thinking as the process of creatng thoughts that produce and focus energy, which in turn brings about positve outcomes. One research study of cancer patents who had a spontaneous remission found only one factor common to each person they examined. Everyone in the study had changed his or her attude prior to remission and, in some way, had found hope. Each of our lives is infuenced by a number of outside factors, many of which we cannot control. Your attude, however, refects the ways in which you respond to what is happening to you. Caring Ambassadors Hepatitis C Choices: 4th Edition How you adapt to situatons and the actons you take can afect your health and may infuence your recovery. Some believe that every thought you have produces a reacton in each cell in your body, from the top of your head to the tps of your toes. They believe the body is constantly reactng to thoughts, whether those thoughts are based on real situatons or your imaginaton. According to this belief, your body becomes an obedient servant of your mind, reactng with the emotonal intensity that you associate with your thoughts. Pleasant thoughts produce pleasant feelings; unpleasant thoughts produce unpleasant feelings. Every tme your life is not going according to plan or presents you with a challenge, try thinking of it as an opportunity. Challenges and disappointments can be opportunites to try new approaches, to amass more know-how, and to exercise your brainpower. We are only beginning to discover the powerful interactons between our minds and bodies. When you consider the miracle of the human body, it is not hard to believe that it is capable of contributng to its own healing. Lifestyle Changes and Personal Habits Changing your lifestyle and personal habits to reduce the efects of chronic hepatts C may be one of the hardest things you do in your life. It is much easier to address problems you may experience if you have support and proper medical care. Many professionals consider sleep to be the most fundamental practce associated with good health. We all experience situatons that can keep us up around the clock, if we allow it to happen. While adequate sleep is crucial for everyone, it is partcularly vital for those living with a long-term disease such as hepatts C. Lack of sleep ofen intensifes anxious and/or depressed feelings creatng a vicious cycle. It is important to get the help you need to end this cycle, and to ensure yourself a healthy amount of sleep. A large study from the United Kingdom showed that decreased amounts of sleep over tme was associated with a signifcantly increased risk of cardiovascular death. The same study mentoned above also found that people who signifcantly increase their nightly sleep over prolonged periods of tme also have increased mortality rates due to non-cardiac causes. Listening to your own body is the best way to know if you are getng adequate sleep. If you require a jolt of cafeine every morning to awaken fully, feel uncharacteristcally irritable, fall asleep during tasks, or otherwise feel tred throughout the day, you may not be getng sufcient sleep. One way to determine how much sleep you need is to keep an actvity diary for a month. Keep track daily of the quantty and quality of your sleep, your daytme actvites, and your mood. By looking at the paterns in your diary, it will become clear what amount of sleep is best for you. Chapter 4: Understanding Hepatitis C Disease Section 2: Promoting Liver Health Exercise: Staying Actve Many people do not realize the central role of exercise in maintaining good health. People who exercise regularly not only feel beter, but also ofen respond more positvely to medical treatment. They have shown increased natural killer cell actvity and increased speed and magnitude of antbody response. Everyday actvites such as housework, gardening, raking leaves, and walking the dog all “count” as exercise because they are forms of physical actvity. They improve mood, relieve pain, increase red blood cell producton, and reduce the amount of cortsol in the blood. Moderate exercise performed regularly boosts the immune system and increases resistance to disease. However, extreme exercise such as marathon running causes immediate suppression of the immune system. To counter this risk, some experts advise people with liver disease to incorporate weight-bearing exercises into their exercise routne because weight bearing strengthens bones. Moderate exercise may help counter and/or reduce the impact of this muscle destructon. By building strong bones and muscles, you can build up a reserve to help fght of some of the physical complicatons of liver disease. It is important to drink plenty of water before, during, and afer any type of exercise to prevent dehydraton. If you have a massage afer exercising, it is especially important to drink plenty of water to fush out the toxins released into the blood by the massage. Review your exercise program with your healthcare provider to make sure your routne is healthy for you. There may be days, or even weeks or months, during which you may not be able to engage in your normal exercise routne. When you are not up to your normal routne, you may want to consider other gentle forms of exercise such as qi gong, tai chi, or yoga. See Chapter 13, Mind-Body Medicine and Spiritual Healing for more informaton on these forms of exercise. The grade of steatosis (fat in the liver) decreased in all seven patents, and the fbrosis score was reduced in three of the seven patents. Caring Ambassadors Hepatitis C Choices: 4th Edition Sexual Actvity When frst diagnosed with hepatts C, many people become fearful about contnuing their sex life. What is normal is diferent for everyone, but according to a study by researchers at Wilkes University, sexual actvity can beneft your im mune system. Many people fnd thinking of themselves as sexual beings, regardless of whether or not they partcipate in sexual actv ity, helps them develop a greater ability to enjoy life. The feelings we have when we are sexually aware are sufcient to alleviate a variety of physical and emotonal ills. As a form of physical exercise, sexual actvity helps trigger endorphin release creatng a more posi tve attude. Sexual actvity allows you to relax and, at least for a tme, to forget about some of your troubles. Your sexuality can go a long way toward enhancing the healing process and creatng an environment for a beter functoning immune system. There is an almost universal concern about passing the virus on to others through sexual actvity. This means using latex condoms correctly and consistently with every sexual encounter. If it is applicable to your situaton, talk with your healthcare provider about whether you should avoid certain sexual practces such as rough sex, “high risk” sexual actvites, and sex while menstruatng. Stress can suppress the immune system, which may cause you to be more vulnerable to disease.


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